A portal for beating-heart surgery

When a patient needs a cardiac intervention, surgeons can choose to access the heart in one of two ways: open-heart surgery or a cardiac catheterization.

Open-heart surgery offers clear and direct access to the heart, but it also requires stopping the heart, draining the blood, and putting the patient on an external heart and lung machine. Catheterization—insertion of a thin, flexible tube through the patient’s groin and up into the still-beating heart—is less invasive. But it’s not suitable for very complicated situations, because it is hard to manipulate the heart tissue with catheter-based tools from such a far distance.

Both methods have been highly optimized, but each has its own risks, benefits and drawbacks. Wouldn’t it be nice if there were a way to directly access the heart and maintain normal heart function and blood flow while repairs are performed?

The best of both worlds

Vasilyev with Cardioport

Vasilyev’s device, called the Cardioport, is a cylindrical tube about .5 inches in diameter. It is inserted directly into the chest via a small incision below the sternum and creates a narrow tunnel straight to a beating heart. Small surgical tools are passed through the port, including some that cannot be deployed via catheter. Thus, the Cardioport enables more complicated minimally invasive operations. Another central feature is a transparent cap with a mechanism that displaces blood inside the heart, allowing surgeons to visualize the procedure without draining all the heart’s blood.

Cardioport procedures have been described as surgical hybrids, “but that word is not quite right,” Vasilyev says. “Hybrid means a mix of two things, and this is really an entirely new thing.”

The port has been used successfully in studies with large animal models to close atrial septal defects (ASDs), holes in the wall that separates the upper heart chambers. Vasilyev and his team are in the planning stages for a clinical trial on humans.

Vasliyev forsees using the Cardioport in cases that require open-heart surgery as well. If surgeons notice a small error, such as a botched suture after a procedure is finished, they may opt to use the Cardioport instead of opening up the hearta second time.

The current current model of the Cardioport device is the result of eight years of careful research and engineering, supported by grants from MIT, the Center for Integration of Medicine and Innovative Technology (CIMIT), the University of Massachusetts and Boston Children’s Technology Development Fund.

Vasilyev thinks Cardioport may be the first of “a family of instruments for intra-cardiac repairs.” He terms it a “platform technology” not only because it provides a literal platform for surgery, but because it calls on surgeons to innovate further. Are there other potential uses the inventors did not foresee? Might there be applications outside of cardiology? For now, the Cardioport remains charged with potential.